Neurotrauma refers to any injury to the nervous system, including the brain, spinal cord, or nerves, caused by external forces like accidents, falls, or sports activities. The ongoing growth and development of children’s bodies and nervous systems render them more susceptible to the consequences of TBI. Traumatic brain injuries (TBI) can be mild or severe, requiring immediate medical care. Spinal injuries assess the spine’s ability to protect the spinal cord and any loss of movement or sensation. Common symptoms include headaches, vomiting, confusion, weakness, numbness, or unusual sleepiness. If a serious accident occurs, imaging tests like CT scans or MRIs may be needed to understand the injury better. The goal of treating neurotrauma is not just to manage the immediate injury but to help children fully recover and regain normal function. Children’s bodies are resilient, and with the right care and rehabilitation, they often recover better than initially expected. Treatment typically involves emergency care followed by rehabilitation to address any long-term functional impairments.

Types of neurotrauma

1. Traumatic brain injury

Traumatic Brain Injury (TBI) is a significant global disability and death cause resulting from external mechanical force. Treatment options vary based on severity, with mild TBI typically managed through rest and symptom monitoring. Moderate to severe TBI may require intensive medical interventions, including surgical treatment, medications, and rehabilitation programs. Case studies provide a valuable resource for understanding the multifaceted nature of TBI treatment and its outcomes.

Falls, motor vehicle accidents, sports injuries, and assaults are among the most frequent causes of TBI. Severity ranges from mild to severe, with symptoms including headaches, confusion, memory loss, dizziness, loss of consciousness, and seizures.

2.  Spinal cord injury

Spinal Cord Injury (SCI) is a condition resulting from traumatic events, often causing motor, sensory, and autonomic dysfunction. Road accidents, falls, violence, and sports injuries are among the leading causes. Symptoms include paralysis, loss of sensation, difficulty breathing, and bowel and bladder dysfunction. The cauda equina, a collection of nerves at the lower end of the spinal cord, can also be damaged in cases of SCI. The spinal cord transmits and receives signals between the brain and the body, causing permanent changes in strength, feeling, and body functions below the injury site.

3. Peripheral nerve injury

Peripheral nerve injury is a condition involving damage to nerves outside the brain and spinal cord, which transmit signals between the central nervous system and the body. Causes include lacerations, compression, stretching, or crush injuries. Common symptoms include localized pain, muscle weakness, numbness, tingling, or complete loss of function in the affected area.

Diagnosis of neurotrauma in children

Diagnosis 

Neurotrauma diagnosis in children involves a comprehensive clinical evaluation, including symptoms, consciousness level, and neurological functions. The Glasgow Coma Scale (GCS) is used to measure these levels. As part of a neurological examination, a patient’s mental status is assessed, as well as the function of the cranial nerves, motor and sensory responses, reflexes, and coordination. Imaging techniques are essential for accurately assessing the extent of the injury and guiding treatment decisions. Computed Tomography (CT) scans to detect bleeding, skull fractures, brain contusions, or oedema, while Magnetic Resonance Imaging (MRI) offers detailed views of brain structures. X-rays are used to diagnose skull fractures and spinal misalignments. For spinal cord or peripheral nerve injuries, nerve conduction studies and electromyography (EMG) are used to assess the extent of nerve damage and function. These tests measure electrical activity in muscles and the speed of nerve signal transmission, aiding in the diagnosis of peripheral nerve injuries or spinal cord injuries.

Prognosis

Factors like injury type, severity, age, other injuries, and treatment speed influence neurotrauma prognosis in children. Generally, children have a better prognosis due to brain plasticity during developmental years, but long-term outcomes can still vary significantly.

Traumatic Brain Injury (TBI) can be categorized into mild, moderate, and diffuse axonal injury (DAI). Mild TBI usually recovers within a few weeks, while moderate to severe TBI can cause long-term physical, cognitive, and emotional difficulties. DAI has a poor prognosis, often leading to coma or persistent vegetative states and may require extensive care and rehabilitation. Outcomes depend on the severity of axonal damage and early intervention response.

Spinal Cord Injuries (SCIs) can be classified as complete or incomplete. Complete SCI leads to poor recovery, permanent paralysis, and respiratory issues. Incomplete SCI, particularly if partially damaged, can recover significantly. Rehabilitation, physical therapy, and early intervention can improve motor function and reduce disability. Long-term effects include permanent paralysis, bowel and bladder control loss, and respiratory issues.

Peripheral nerve injuries can be mild to moderate, with the potential for full or partial recovery with early rehabilitation. Children have better regeneration potential than adults. Long-term effects may include persistent weakness or sensory deficits. Severe nerve damage may require surgical repair, and recovery can be slow and incomplete. In cases where nerve function does not fully recover, children may experience permanent deficits like motor weakness or loss of sensation.

Neurotrauma in children can lead to long-term learning and memory deficits, academic struggles, and mood swings. Early intervention and therapy can help children recover, while severe cases may require surgery. Psychological support and counselling are often necessary to help children manage emotions and cope with the emotional impact of neurotrauma.

Dr. Vishakha Patil, a specialist, explains neurotrauma’s medical management, which includes immediate interventions, diagnostic imaging, and long-term rehabilitation strategies. He emphasizes the importance of awareness, prevention, and timely treatment to minimize complications related to neurotrauma, such as wearing helmets and seatbelts.

Neurotrauma is a complex medical issue affecting individuals, families, and healthcare systems. Early recognition, treatment, and rehabilitation are crucial to minimize its impact. Prevention, education, and research are also vital to reduce the global burden of neurotrauma. Children are particularly vulnerable to neurotrauma due to its long-term impact on physical and cognitive development. Awareness of causes, symptoms, and management strategies can help caregivers and healthcare providers take prompt action. Prioritizing prevention and early intervention can improve outcomes for affected children.

About Dr Vishakha : 

Dr Vishakha Basavraj Karpe, a highly skilled senior consultant at Rainbow Children’s Hospital in Banjara Hills and Hydernagar Hyderabad. She is known for her comprehensive care approach and is one of the few dedicated leading paediatric neurosurgeons in the city and India with over ten years of extensive experience in pediatric neurosurgery. Her expertise includes treating hydrocephalus, spinal dysraphism, craniosynostosis, paediatric brain infections, and brain and spine tumours and stroke surgery. 

She has special interest  in craniosynostosis surgery, which is done only in very few centres in India.

Proficiency of Dr Vishakha:

1. 1. Hydrocephalus (increased fluid in the brain): The procedure involves an endoscopic third ventriculostomy and CSF diversion (VP shunt) to treat complex hydrocephalus.
   2. Craniosynostosis (abnormal head shape due to untimely cranial sutures fusion) surgeries: Helmet therapy is a technique that is used in both endoscopic and open surgery.

• Spinal dysraphisms(Spina Bifida)- (spinal abnormalities present by birth) – surgical repair

• Encepahaocles repair surgery.

1. 1. Vascular conditions and stroke surgeries: revascularization surgeries for moya moya disease.

• Pediatric brain and spine tumour surgeries.

1. 1. Pediatric brain and spine infection surgeries: Endoscopic and open surgeries for brain and spine infections.

• Pediatric traumatic brain and spinal injury.

• Antenatal counselling for congenital fatal neurosurgical conditions.